Dermatologic surgeryAn evolving paradigm for the workup and management of high-risk cutaneous squamous cell carcinoma
Section snippets
Methods
The study design was approved by the institutional review board at Columbia University Medical Center, New York, NY. A retrospective chart review was performed on cases of HCSCC and VCSCC identified among patients seen in the Mohs micrographic surgical division at Columbia University Medical Center between 2000 and 2011. HCSCC was defined as a tumor possessing 3 or more high-risk features on initial clinical and histologic evaluation, including location on the head and neck, size greater than
Results
In all, 1591 cases of CSCC were treated between 2000 and 2012. A total of 27 patients with HCSCC or VCSCC were identified and included in the study (Table I; available at http://www.jaad.org).
Five qualified as having HCSCC: 4 were treated with surgery, and 1 with surgery and adjuvant radiation. All remain disease-free with no evidence of progression or recurrence, with a median follow-up of 5 years.
In all, 22 patients with VCSCC were identified. Four were treated with surgery alone. In this
Discussion
When evaluating a patient with CSCC, there are many risk factors to consider that might increase the likelihood of recurrence or metastasis. Many studies and published guidelines attempt to clarify these characteristics, which include: diameter greater than 2 cm; thickness greater than 2 mm; Clark level greater than IV (invasion into subcutaneous fat); perineural invasion (sometimes limited to “large caliber”); degree of histologic differentiation; host immunosuppression; recurrence; growth in
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Conflicts of interest: None declared.